Effects of Hemoadsorption on Vascular Integrity in Septic Shock

Inclusion Criteria: * Septic shock as defined by Sepsis-3 criteria. * Serum lactate levels \>2 and \<8 mmol/L at screening. * Fluid unresponsiveness: Objectively confirmed via dynamic tests or fluid challenges following initial resuscitation. * Vasopressor Dose Threshold: Norepinephrine base equivalent (NEE) dose \> 0.5 µg/kg/min. * Systemic corticosteroid treatment on board for at least 30 minutes. * Tissue perfusion impairment: Persistently elevated serum lactate AND/OR prolonged capillary refill time (\> 3 seconds) despite standard therapy. * Alternative causes of shock (e.g., obstructive or cardiogenic) must be ruled out using critical care ultrasonography (CCUS). * Arterial, central venous catheters and an invasive hemodynamic device (PiCCO, Getinge) in place. * Inclusion within a maximum of 12 hours after the onset of vasopressor need. * High likelihood of a dysregulated immune response (PCT ≥ 5 ng/mL AND/OR IL-6 ≥ 1000 pg/mL AND/OR Ferritin ≥ 1000 ng/mL). * Written informed, retrospective or prospective consent. Exclusion Criteria: * Patients under 18 years of age and over 80. * Unlikely to survive for 24 hours (Moribund). * Pregnancy. * SOFA-2 score ≥ 16 at ICU admission. * Source control is uncertain. * Thrombocytopenia (\<20,000/µL). * Criteria of standard guideline-based medical treatment not exhausted. * End-stage organ failure (chronic renal failure (estimated glomerular filtration rate (eGFR) \<15 mL/min/1.73 m2), chronic liver failure (MELD Score \>30, Child…